The Treatment of an Exaggerated Fear
Often, those who have particular fears, such as the fear of cancer or of a panic attack, have other fears also. Generalized Anxiety Disorder is not so much a particular illness as it is a description of someone who is fearful of one thing after another. Although these fears are discrete and seemingly dissimilar, they represent a certain inclination in general to be afraid—fearful of illness, or of strangers—fearful of things going suddenly, terribly, wrong for no obvious reason. There is always the potential for catastrophe. Whether these affected men and women are afraid of additives in food, for example, or a terrorist attack, the sense of foreboding is the same. They always have their antennae out looking for some sign of danger. Whatever the danger, their reaction is the same: an attempt to uncover that danger as soon as possible and ward it off. These precautions seem exaggerated and irrational to others.
Since these dangers are many, the anxious person is hard to reassure. One worry is replaced by another. However, every once in a while, defeating one fear seems to spill over to others and may significantly affect the tendency to worry in general. I report such a case here.
A twenty-six year old woman who had just given birth to a daughter a month previously attended our Health Anxiety clinic complaining that she had not been able to sleep since the birth of the child. Of course, a new mother is not likely to get a good night’s sleep. I tell expectant parents that both can expect to be tired for the next few months because of the baby’s waking up repeatedly during the night. But this young woman could not sleep even when her baby was sleeping. She knew about Sudden Infant Death Syndrome in which a baby who seems healthy dies for no obvious reason during the course of the night; and she worried that her daughter might die in such a way. Consequently, she awoke every few minutes in order to go into the nursery to make sure her daughter was breathing. Finding her still breathing each time did not make her feel confident that the next time around she would still be alive.
Infant Death Syndrome
SIDS is a real condition, uncommon, but not rare, which is, as my patient imagined it, a sudden, inexplicable and terrible event. Not much is known about the cause. Certain measures, such as having the baby sleep on its back, make the disorder less likely. There are a few other similar precautions that can be taken. Still, such a thing can happen. Because it happens quickly, constant surveillance is not useful or recommended. All of this my patient knew. Nevertheless, for the same reason a person obsessively worried about germs washes her hands over and over again, she checked her child over and over again.
Checking behaviors serve momentarily to reassure, but in the long run reminds the worried individual that the underlying danger is always there. Washing one’s hands endlessly keeps fresh in mind the danger of germs. Similarly, checking the stove, or a door to see if it is locked, worsens the underlying fear! Treatment, therefore, is the prevention of the checking response. Indeed, the treatment is called exposure and response prevention.
Recommendations:
- It is important to understand as much as possible the real danger of the feared event. Contrary to the usual recommendation, I suggested that my patient read up on SIDS in order to better understand the risk. As usual, she became initially more worried as she read about one awful case after another. But quickly she became less anxious as she came to understand just how unlikely such an untoward event would be. Confronting any fear elicits the same response: first more fear, then less. If the fear turns out to be justified, learning more about the danger sometimes allows realistic measures to be undertaken to lessen the risk. Along the way, this young woman came to understand that she was not protecting her child by checking on her..
- She was instructed not to go into the nursery to check on her baby unless her child was crying. Telling a compulsive person to stop checking is not likely to achieve that result. The habit is too ingrained. But this woman was new to this particular concern. And she was desperate. Consequently, with some misgivings she refrained from checking. After only one week, all thoughts of SIDS vanished from her mind; and she was able to sleep.
What was unexpected by me, however, was the fact that various other fears that had haunted her from time to time—mostly of physical disease—also disappeared at the same time. I am not sure why; but I think that she may have discovered similar strategies for dealing with those fears. (c) Fredric Neuman Author of “Caring.”